502700869-8-7-2023-27-AS-SRIN-CURRQD-20230816131321

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700869
Report Date: 08/07/2023
Date Signed: 08/07/2023 03:13:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/28/2023 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20230328140424

FACILITY NAME:	ORANGEBURG MANOR		FACILITY NUMBER:	502700869
ADMINISTRATOR:	ARBIOS, MARIE		FACILITY TYPE:	740
ADDRESS:	1248 NELSON AVENUE		TELEPHONE:	(209) 527-2222
CITY:	MODESTO	STATE: CA	ZIP CODE:	95350
CAPACITY:	90	CENSUS: 32	DATE:	08/07/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Resident Care Director Jeanine Gaona		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident's dietary needs are not being met.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA Lund met with Resident Care Director Jeanine Gaona and explained the reason for the visit.
Resident's dietary needs are not being met- Based on facility records reviewed, interviews with staff, residents & LPA Lund observation. Facility records show the residents do not have dietary needs for sugar free coffee creamer and residents have the right to choose what type of creamer they would like in moderation. The facility does offer both sugar free & regular (Sugar) creamer. Staff make the coffee and ask residents what type of creamer if needed. LPA Lund interviewed Resident Care Director Jeanine Gaona who stated that “None of the Residents Dietary Communication Notification forms state what type of creamer they have to have. Staff try to persuade the residents who have diabetes to have sugar free creamer, but it is still residents’ choice.”

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230328140424

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ORANGEBURG MANOR	FACILITY NUMBER: 502700869
	VISIT DATE: 08/07/2023

NARRATIVE

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Based on facility records reviewed, interviews with staff, residents, & LPA Lund’s observation the information provided, it was unclear if resident's dietary needs are not being met therefore the allegation was deemed UNSUBSTANTIATED.

A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted with Resident Care Director Jeanine Gaona and a copy was left.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023

LIC9099 (FAS) - (06/04)

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